This new job is fascinating. I'm working out in a rural county - about an hour away from the major metropolitan area where I live - and in only a month, the way I practice has changed. Dramatically.

My residency was a pretty large hospital, and served as a massive referral hub for hundreds of miles around. We were the catchment for millions of people, which meant that all of the sickest people came to us. I was impeccably trained. People were sick.

Out here, though? Rough guess is that we serve 100,000 total people, and that might be pushing it. Interestingly enough, since there's only one hospital in the area, we see the true flavor of what the community really suffers from. It's not thousands of square miles of sickness condensed into one place. Out here, there's no doctor shopping. If you need to go to the ER, you come to us.

For the most part, the nurses, techs, and even some of the doctors are from around the community. That means that many of the patients are neighbors or friends... or the town drunk. We even have a family euphemistically referred to by the staff as "the shallowest gene pool in the county". It's a very dramatic example of inbreeding, the likes of which I've quite honestly never experienced.

I'll give you an example.

Registration: "Ma'am, when's your birthday?"

Patient (after a moment of thought): "After Thanksgiving."

Registration: "...I see. What year?"

Patient (lisping): "I have a birthday every year!"

She's in her 50's. If the rumors from the rest of the family are true, she's dating her nephew. As an aside, the above conversation is verbatim. No embellishments here. Can't make this shit up.

The "regular" ER visits are now a bit less... regular. Gored by a bull. Run over by a tractor. Wants her vagina examined again by "the cute doctor who works at night" (not me, thankfully. As an aside, the poor doc in question refuses do pelvic exams on this patient because she creeps the shit out of him). It's a whole new world, and I am loving it.